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Www.haciric.org Technological innovation for elderly care. Reconfiguring services and reconfiguring infrastructure Improving the Hospital Performance in
www.haciric.org Technological innovation for elderly care.
Reconfiguring services and reconfiguring infrastructure Improving
the Hospital Performance in Economic Crisis EUREGIO III Masterclass
Programme 23 March 2011 Instituto De Higiene E Medicina Tropical
Universidade Nova De Lisboa Lisbon James Barlow
Slide 2
Part 1 the innovation paradox in healthcare
Slide 3
We need technological innovation to cope with the big 21 st
century healthcare challenges...
Slide 4
... but while innovation is part of the solution, its also part
of the problem Medical & diagnostic equipment innovations
increase access to care close to / at home....... New
pharmaceuticals reduce the requirement for in- patient care.......
Advances in surgery improve outcomes and reduce lengths of
stay.......... this generates new costs in primary / social care
sector.... this increases demand for long term support... this
extends the range of eligible patients but
Slide 5
Remote care = good example of a technological innovation that
offers huge potential But it also unlocks new challenges Some of
these impact on the built infrastructure for healthcare
Slide 6
Part 2 What is remote care?
Slide 7
Remote care Information & advice Safety & security
monitoring Vital signs monitoring Lifestyle monitoring
Slide 8
Practice by Telephone The Yankees are rapidly finding out the
benefits of the telephone. A newly made grandmamma, we are told,
was recently awakened by the bell at midnight, and told by her
inexperienced daughter, "Baby has the croup. What shall I do with
it?" Grandmamma replied she would call the family doctor, and would
be there in a minute. Grandmamma woke the doctor, and told him the
terrible news. He in turn asked to be put in telephonic
communication with the anxious mamma. "Lift the child to the
telephone, and let me hear it cough," he commands. The child is
lifted, and it coughs. "That's not the croup," he declares, and
declines to leave his house on such small matters. He advises
grandmamma also to stay in bed: and, all anxiety quieted, the trio
settle down happy for the night The Lancet 29 Nov 1879, Page 819
With thanks to Nicholas Robinson
Slide 9
its arrival has been heralded throughout the last decade "The
innovations we will encounter as we step beyond feasibility are
dazzling in their potential" R. Merrell, Yale University School of
Medicine, 1995 "Over the next decade, the telemedicine industry
will expand into new markets and service areas. Furthermore, its
rapid rise will have a profound impact on the delivery and quality
of medical care worldwide. In the United States alone, we expect
telemedicine will represent at least 15 percent of all health care
expenditures by 2010 Telemedicine Industry Report 2000 Telecare has
arrived. This years annual review reflects the transformation of
our sector from social alarms to Telecare, and the repositioning of
the Telecare service model from the periphery of housing, social
care and health to centre stage Association of Social Alarms
providers, 2004 2008: The year telecare grows up? E- Health
Insider, 2007 With thanks to ?What If!
Slide 10
The terminology Telecare Telehealth Telemonitoring Telemedicine
Assistive technology Smart homes All are used interchangeably to
describe the remote delivery of health and social care
Slide 11
Some remote care is relatively simple... TelemedicineTelecare /
telehealth Aimed at diagnosis or referral, usually focusing on
specific conditions Brings care directly to the end-user generally
in a non-institutional setting Lots of tele-ologies (e.g.
teledermatology, teleradiology) Focus on monitoring for prevention
or safety and security, or advice and support Essentially a B2B
model (patient may or may not be present) Essentially a B2C model
(patient always present) Few stakeholders so relatively easy to
implement Many stakeholders so far more complex and inherently
harder to implement
Slide 12
TelemedicineTelecare / telehealth Aimed at diagnosis or
referral, usually focusing on specific conditions Brings care
directly to the end-user generally in a non-institutional setting
Lots of tele-ologies (e.g. teledermatology, teleradiology) Focus on
monitoring for prevention or safety and security, or advice and
support Essentially a B2B model (patient may or may not be present)
Essentially a B2C model (patient always present) Few stakeholders
so relatively easy to implement Many stakeholders so far more
complex and inherently harder to implement but some is
complex...
Slide 13
TelemedicineTelecare / telehealth Aimed at diagnosis or
referral, usually focusing on specific conditions Brings care
directly to the end-user generally in a non-institutional setting
Lots of tele-ologies (e.g. teledermatology, teleradiology) Focus on
monitoring for prevention or safety and security, or advice and
support Essentially a B2B model (patient may or may not be present)
Essentially a B2C model (patient always present) Few stakeholders
so relatively easy to implement Many stakeholders so far more
complex and inherently harder to implement
Slide 14
Remote care applications Information & communication, e.g.
health advice, virtual self-help groups Safety and security
monitoring, e.g. Bath overflowing, gas left on, door unlocked
Individual monitoring: Physiological signs Lifestyle / activities
Electronic assistive technology, e.g. environmental controls, doors
opening/closing, control of beds Improving functionality Mitigating
risk The individual in their home or wider environment
Prevention
Slide 15
Remote care applications Information & communication, e.g.
health advice, virtual self-help groups Safety and security
monitoring, e.g. Bath overflowing, gas left on, door unlocked
Individual monitoring: Physiological signs Lifestyle / activities
Electronic assistive technology, e.g. environmental controls, doors
opening/closing, control of beds Improving functionality Mitigating
risk The individual in their home or wider environment Prevention
UK 1 st generation (1970s - ) UK 2 nd generation (2005 - ) UK minor
development so far
Slide 16
Part 3 why remote care is important
Slide 17
ageing population public expenditure constraints healthcare
cost inflation rising chronic disease Based on a figure by Laurie
McMahon A perfect storm for health and social care budgets is
emerging 2008
Slide 18
Dealing with this perfect storm will require innovative
healthcare business models new configurations of services,
technology and infrastructure ... including remote care
Slide 19
Potential remote care benefits Risk management: move patients
from expensive care settings (e.g. hospitals, nursing homes) to
lower cost environments (patients home, intermediate care facility)
Prevention: monitor at risk populations more closely to enable
earlier identification of problems and earlier intervention
Patient-centred approach: choice over care packages, location of
care delivery Better quality of life / better outcomes (?)
Slide 20
Part 4 progress made towards remote care implementation
Slide 21
Policy in the United Kingdom The UK has taken a strong lead.
Well over 20 government reports since 1998 have called for telecare
Finance (170m +) via Preventative Technology Grant, Whole System
Demonstrators and other initiatives Organisational infrastructure
for support
Slide 22
There are many case studies and other reports
Slide 23
What does the remote care evidence base look like? Source:
Barlow et al (2007) Very large number of studies around the world
(10,000+ published reports?) Clinical / QoL benefits are being
shown But very little robust economic evidence but modelling
highlights the potential benefits Bulk of studies are targeted at
diabetes and heart disease
Slide 24
Growth in remote care users in England... with many assumptions
Source: Based on CQC returns, JIT (Scotland) data, and authors
research for WAG. Includes LA and other agency services. Assumes
30% drop-out rate each year With Scotland & Wales Assumes
15,000 remote care users (2005) and 5000 users (2000)
Slide 25
How big is the potential market? Potential remote care market
2010 1,400,000 Actual remote care market 2010 350,000 Potential
telehealth market 2010 450,000 Actual telehealth market 2010 22,500
Source: based on CQC returns, JIT (Scotland) data, and authors
research for WAG. Telehealth figures from Minutes of the Strategic
Intelligence Monitor on Personal Health Systems [SIMPHS] meeting,
Brussels, 17-18 November 2009. Assumptions: UK population aged 75+
rises from 4.9m (2010) today to 11.4m by 2050 c85% of older people
wish to remain at home as long as possible 1/3 needs remote care at
any given time
Slide 26
Telemedicine in Portugal Telemedicine has been developing, e.g.
in Alentejo 90,000 consultations using telemedicine 1998 2009
Teleconsultation (cardiology, dermatology) and teleradiology Local
health providers, hospitals in Lisbon, Oporto and other Portuguese
cities, and regional Spanish hospitals Quicker than face-to-face
consultations Provides GPs with specialist knowledge thus reducing
referrals Changes the distribution of health expertise, services
and infrastructure Tiago Cravo Oliveira Doctoral Candidate,
Imperial College Business School [email protected]
Slide 27
Part 5 what are the implications of remote care for healthcare
infrastructure?
Slide 28
Remote care is part of the next generation of healthcare
infrastructure renewal
Slide 29
There are tantalising glimpses into the potential of remote
care
Slide 30
Simulation modelling can help us think about how remote care
might change care services and what the potential impact might be
NB the figures arent important in these examples
Slide 31
Frail elderly care 2051015 Source: Bayer & Barlow (2007) A
20% decline in demand for care home places? Falling (initially)
hospital admissions?
Slide 32
20% reduction Cost of telecare package compared to a
conventional care package Change in costs Effect of telecare on
entry into institutional care Effect on frail elderly care costs 3
- 5% reduction in costs
Slide 33
Chronic heart failure Source: Bayer & Barlow (2006)
Stabilisation in the demand for hospital admissions?
Slide 34
Stroke care Source: Cox et al (2010) c20% decline in hospital
bed days and c5% decline in care home bed days?
Slide 35
Will remote care reinforce the emerging faultline in healthcare
infrastructure? Tertiary care Traditional in-patient hospital care
Community care Home and family With thanks to Laurie McMahon
Slide 36
... and will hospitals be able to cope?
Slide 37
The challenge How to coordinate, plan and deliver Healthcare
infrastructure Services Technology investment In highly complex,
fast- moving environments
Slide 38
Lessons 1 New technologies can help to address the big
challenges in care provision how to do more for less Remote care
will play a part in shifting the balance of care from high cost to
lower cost settings So we need to think about the future role of
hospitals and other expensive infrastructure But it wont
necessarily reduce overall healthcare costs
Slide 39
Lessons 2 Its about understanding services, technologies and
infrastructure as a system